Active NPI
Blossom Eloho Odemudia, PHARMD
- Pharmacist
- Eugene, OR
National Provider Identifier
1932703600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18459
- Practice address
- 4740 Royal Ave
Eugene, OR 97402-1755 - Phone
- (541) 688-6497
- NPI assigned
- Nov 24, 2020
- Last updated
- Feb 14, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 18459 | OK | Primary |
Addresses
Primary practice location
4740 Royal Ave
Eugene, OR 97402-1755
Mailing address
4740 Royal Ave
Eugene, OR 97402-1755
Phone (541) 688-6497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18459 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oklahoma CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676332800000",
"number": "1932703600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4740 ROYAL AVE",
"city": "EUGENE",
"state": "OR",
"postal_code": "974021755",
"telephone_number": "541-688-6497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4740 ROYAL AVE",
"city": "EUGENE",
"state": "OR",
"postal_code": "974021755",
"telephone_number": "541-688-6497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODEMUDIA",
"first_name": "BLOSSOM",
"middle_name": "ELOHO",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-24",
"last_updated": "2023-02-14",
"certification_date": "2023-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "18459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.